14100106 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 414G CONTRACTOR: BAY AREA PERMIT NO: 14100106
ENTERPRISE
OWNER'S NAME: LEMIRE GERARD S TRUSTEE 2110 MANGIN WAY DATE ISSUED: 10/23/2014
OWNER'S PHONE: 6503214558 SAN JOSE, CA 95148 PI[ONE NO:(408)238-5043
❑ LICENSED CONrRAcrOR'S DECLARATION j-
r / BUILDING PERMIT INFO: BLDG ELH;Cr PLUMB
License Class Lic.# f
MECH RESIDENTIAL COMMERCIAL
Contractor ��c ►�� Date 'L �� JOB DESCRIPTION: INTERIOR REMODEL(195 SQ P"f)INCI,UDP,ING CREn MNG
11 AN OPENING TO UNIT 412G(SEE PERMIT 141001 15)
1Jpheby affirm hat 1 am licensed under the provisions o Chapter 9
( mencing with Section 7000)of Division 3 of the Business&Professions
and that my license is in full force and effect.
1eby affirm under penalty of perjury one of the following two declarations:
Ie and will maintain a certificate of consent to self-insure for Worker's
Censation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued, Sq.Ft Floor Area: Valuation:$28000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
APN Number:34253196.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARRED
correct. I agree to comply with all city and cou ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize e esentatives of this city to enter
upon the above mentioned property for inspe do purposes. (We)agree to save I$� AYS FRO ST CALLED INSPECTION.
indemnify and keep harmless the City of Cu ert o against liabilities,judgments,
costs,and expenses which may accrue agai st aid City in consequence of the � Z�
granting of this permit Addi nally,the scant understands and will comply Issued b Date-.//
with all non-point sour
e re lations per t e Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date I All roofs shall be inspected prior to any roofing material being installed. If a rool'is
installed without first obtaining an inspection,I agree to remove all new materiab for
inspection.
❑ OWNER- t1tLDER'DF,CLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sce.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of file
California health&Safety Code,Sections 25505,25533, 25534. I will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Cod , .hapter 9.12 and the
declarations: health&Safety Code,Section 25532(x)should store andle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipme or dev. e which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area it QuPC
Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cup tin MunicCode,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the health&Safety Code,Sections 25 5 533,a 534.
Section 3700 of the Labor Code,for the performance of the work for which this d 1 2 /
permit is issued. Owner or authorized agent: Date:`__
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LE.'DING AGN:NCI'
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lendcr's Address
--
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments. ARCI IITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 23500 Cristo Rey Dr(unit 414G) DATE: 1012112014 REVIEWED BY: Sean
APN: BP#: o Q 'VALUATION: 1$8,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Multi-Family Dwelling Buildino is PENTAMATION 1 R2REM
USE: 3 Stories 0 Yes Q No PERMIT TYPE:
WORK Interior remodel 195 sq ftincluding creating an opening to Unit 412G.
SCOPE
El------t- !)t?t[.`[ iil.trpiC ,'1ttE3 Li
LFrrh ha.�r. /<<. %'Iun;l-.lit; ('�._.. �1[<• I;���p: ,•'<':'.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc. . These fees are based on the prelindnarp information available and are only an estimate. Contact the De tor addn'l in o.
FEE ITEMS (Fee Resolulion 11-053 Eff. 711/13] FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Other
Suppl.PC Fee: Q) Reg. 0 OT 0.0 hrs $0.00 $431.00 IREMRESOTH
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced.Planning Fee: $0.00 Select a Non-Residential
!)""' firs[rimcnia!io,i Fccc;: I
Building or Structure
i
Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALSs $2.04 $431.00 TOTAL FEES $433.04
Revised: 08/20/2014
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 414 g cristo rey DATE: 10/20/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$28,000
PERMIT TYPE: Building Permit PLA CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE: A
WORK CREATE N OPENING BETWEEN UNITS 412G & 414G). ADD 23 RECESSED LIGHTS 6 circuits
SCOPE
Elec. Plan Check 0.0 1 hrs $0.00
Elec.Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs $48.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the preliminar information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (1,ee Resolution 11-0531 f 7%1:7.31 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: (j) Reg. 0 OT 0.0 I hrs $0.00 or Element of a Building
PN/1E Plan Check: $0.00 6 Electrical
Permit Fee: Hourly Only? 0 Yes 0 No $0.00 $48.00 IBREMRECEP Recep/Switch/Outlets
Suppl. Insp. Fee:0 Reg. 0 OT F0_01hrs $0.00 23 Electrical
PME Unit Fee: $0.00 $90.00 IBREMFIXT Fixtures, Lighting
PN/[E Permit Fee: $48.00
T-7- I I
Administrative Fee: 1ADMIN $45.00 0
Work Without Permit? 0 Yes No $0.00 G)
Advanced Plannin-1 Fee: $0.00 Select a Non-Residential G)
Travel Documentation Fee: ITRA FDOC $48.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $3.64 = hrs Inspections
Bldg Stds Commission Fee: IBCBSC $2.001 $429.00 1STINSP Inspection, Hourl
SUBTOTALS: $146.64 $567.00 TOTAL FE $713.64
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